Provider Demographics
NPI:1831276955
Name:LATTIN, JEAN MEREDITH (MSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MEREDITH
Last Name:LATTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:LATTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:5650 MARCONI AVENUE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4467
Mailing Address - Country:US
Mailing Address - Phone:916-481-1419
Mailing Address - Fax:916-481-1419
Practice Address - Street 1:5650 MARCONI AVENUE
Practice Address - Street 2:SUITE #1
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4467
Practice Address - Country:US
Practice Address - Phone:916-481-1419
Practice Address - Fax:916-481-1419
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS61361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051138OtherMANAGUL HEALTH NETWORK
CA051138OtherMANAGUL HEALTH NETWORK